Vitamin D and MS. Gavin Giovannoni
|
|
|
- Griffin Conley
- 9 years ago
- Views:
Transcription
1 Vitamin D and MS Gavin Giovannoni
2 Latitude
3 This article was published in McAlpine s Multiple Sclerosis 4 th edition. Compston A. ed. London Churchill Livingstone Elsevier 2006;55 Fig 1.33 Copyright Elsevier (2007) Geographical Distribution of MS First study of geographical distribution of MS prevalence by Davenport Key finding: Geographical variation in MS prevalence, implying population (genetic) and environmental contributions to MS risk Davenport CB. In: Association for Research in Nervous and Medical Conditions (ARNMD), vol 2. New York: Hoeber, 1921;pp8 19.
4 Prevalence of MS in the USA. Kurtzke et al, 1980
5 . Koch-Henriksen and Sorenson, 2010
6 MS-related hospital admissions England Ramagopalan et al, 2011
7 Relationship of MS prevalence to ultraviolet exposure Ramagopalan et al, 2011
8 UVB and MS prevalence in France MS Prevalence by Department Against UVMED Minimum Department UVMed MIN Orton et al. Neurology Feb 1;76(5):
9 Prevalence of MS in Norway Prevalence data for counties in Norway (/10 5 ): A A Finnmark 1 (2003) >83 B B Troms 1 (2003) >104 C Nordland (1999) 106 D Nord Trøndelag (1999) 164 E Oppland 2 (2002) 190 C F Hordaland (2003) 151 G Oslo 2 (2005) 154 D In Norway, MS prevalence does not rise with increasing latitude, unlike other northern European countries and the USA As expected, measured UV radiation levels decrease with increasing latitude F E G Kampman et al, 2007
10 Fish consumption. Kampman et al, 2007
11 Migration
12 Migration studies Compston & Coles, Lancet 2008.
13 The effect of migration on MS prevalence Gale, 1995
14 Prevention
15 vd supplementation
16 Vitamin D and MS Munger et al, 2004
17 Vitamin D and MS Munger et al, 2004
18 vd levels
19 Vitamin D and MS Munger et al, 2006
20 Vitamin D and MS Munger et al, 2006
21 When to supplement?
22 Vitamin D and MS- Month of Birth Role of light exposure in MS supported by month of birth effect In northern hemisphere, significantly more people with MS are born in May (less light during pregnancy) than November (more light during pregnancy) Birth month effect is inverse in the southern hemisphere Willer et al, 2005
23
24
25
26 Familial risk Compston & Coles, Lancet 2008.
27
28 Ramagopalan et al. PLoS Genet Feb;5(2):e
29 Thymic Education Hypothesis Disanto et al. JAMA Neurol Apr;70(4):527-8.
30 Genome-wide vitamin D receptor mapping using ChIP-seq in Lymphoblastoid Cell Lines Ramagopalan et al, 2010
31 Enrichment for genes associated to autoimmune disease and cancer Ramagopalan et al, 2010
32 Can vd be used as a MS disease modifying therapy?
33 static protective factors protective HLA haplotypes Low risk Prevention dynamic protective factors Very low risk Disease Modification Favourable disease-modifying factors At risk High Risk RIS CIS MS static risk factors dynamic risk factors Unfavourable disease-modifying factors family history genetics sex month of birth place of birth 1. Declining Physiology peripheral immunological endophenotype 2. Biological disease threshold CNS endophenotype 3. Asymptomatic disease RIS (abnormal MRI and/or evoked potentials) 4. Clinical disease a. Clinically isolated syndrome (CIS) b. Relapsing MS c. Relapsing secondary progressive MS d. Non-relapsing secondary progressive MS 1 age place of residence outdoor activity / sun exposure / sun screen diet / vitamin D supplements age of exposure to EBV smoking Peripheral immunological changes T-regs (), NK cells, CD8 () CNS changes (OCBs and microscopic pathology) MRI / evoked potentials changes 4b 2 2 Clinical disease 4c 4d 2 In utero childhood Adolescence / early adulthood adulthood a
34 Vitamin D as an early predictor of MS activity and progression Ascherio JAMA Neurol Mar;71(3):
35 Vitamin D as an early predictor of MS activity and progression Ascherio JAMA Neurol Mar;71(3):
36 Vitamin D as an early predictor of MS activity and progression Ascherio JAMA Neurol Mar;71(3):
37 Multivariate International CIS risk factor study - 25-OH D3 P=0.008 P=0.007 Median Survival: 935 days vs days Conversion to CDMS] HR 95% CI P value 25-OH D Kuhle et al. submitted 2014.
38 Higher 25-OH vd is associated with lower relapse risk Simpson et al. Ann Neurol. 2010;68:
39 vd status predicts new brain MRI activity in MS EPIC is a 5-year longitudinal MS cohort study at the UCSF. 469 subjects annual clinical evaluations, brain MRI, and biomarkers. Each 10ng/ml higher vitamin D level was associated with lower subsequent disability (-0.047; 95% CI = to ; p = 0.037). Mowry et al. ANN NEUROL 2012;72:
40 Chicken or Egg Association? Causation?
41 The effect of the systemic inflammatory response on plasma vitamin 25 (OH) D concentrations adjusted for albumin Vitamin D3 CRP Ghashut et al. PLoS One Mar 25;9(3):e Albumin
42 Hypothesis Hypovitaminosis D3 is a consumptive vitaminopathy. Therefore, the association between low vd levels and disease is due to reverse causation. Association? Causation?
43 Immunomodulatory effects of vd in MS Immune response Correale et al. Brain 2009: 132; Vitamin D3
44 Seasonal Effects
45 Seasonal patterns in optic neuritis and MS: a meta-analysis Jin et al. J Neurol Sci 2000:181;56 64.
46 Seasonal prevalence of MS disease activity Meier et al. Neurology 2010;75:
47 vd and disease activity in MS before and during IFN-beta treatment Løken-Amsrud et al. Neurology Jul 17;79(3):
48 Treatment effects
49 The effect of vitamin D-related interventions on multiple sclerosis relapses: a meta-analysis James et al. Mult Scler Oct;19(12):
50 The effect of vitamin D-related interventions on multiple sclerosis relapses: a meta-analysis James et al. Mult Scler Oct;19(12):
51
52 What dose of vitamin D?
53 Vitamin D Status in Primates and Early Humans Winter 43 o N Latitude 40 0 Old-World Primates Slide adapted from Reinhold Vieth Humans exposing full skin surface to Sunshine s UVB Normal Blood Levels when taking 25 mcg/d 1000 IU/day Northern People Taking 100 mcg/d 4000 IU/day Physiological adult intake Sources, include Cosman, Osteoporosis Int 2000; Fuleihan NEJM 1999; Scharla Osteoporosis Int 1998; Vieth AJCN 1999, 2000
54 Maasai median 25(OH)D = 104 nmol/l = 41 ng/ml 40 ng/ml Slide adapted from Reinhold Vieth Luxwolda et al. British Journal of Nutrition (2012), 108,
55 Osteopaenia: z-scores are lower in MSers Lumbar spine Femoral neck (NS) Dobson et al. Mult Scler Nov;18(11):
56 HES data: risk ratio of fractures in MS Fracture (ICD code*) Observed Expected Rate Ratio (95% confidence interval) P value All fractures ( ) <0.001 Ribs (S22.2-S22.4 ) ( ) Clavicle (S42.0) ( ) <0.001 Humerus (S42.2-S42.4, S42.7) ( ) <0.001 Forearm (S52) ( ) Wrist/Hand (S62) ( ) Pelvis/Lumbar spine (S32.0- S32.8) ( ) <0.001 Tibia/Ankle (S82) ( ) <0.001 Foot (S92) ( ) <0.001 Femur - neck of (S72.0-S72.2) ( ) <0.001 Femur - other (S72.3-S72.8) ( ) <0.001 Femur - unspecified (S72.9) ( ) <0.001 Ramagopalan et al. BMC Neurol Nov 5;12:135.
57 MS prevention Population health-based initiatives Conclusions Targeted high-risk population studies (children and siblings of people with MS) Low vd levels are associated with MS disease activity relapses, disease progression and MRI activity (Gd, T2 and brain volume loss) Possible reverse causation The consumptive hypovitaminosis hypothesis Arguments against consumptive hypovitaminosis hypothesis Worldwide MS epidemiology (latitude, migration, sex ratio, changing incidence, MoB effects) Seasonal variation of MS onset and disease activity Current evidence-base regarding treatment is unconvincing We need large well-controlled randomised clinical trials (easier said than done) We need more basic science to support the causation theory What dose? Evolutionary medicine suggests we need to target a blood plasma level above 100nmol/L What advice? To supplement to achieve a year long blood levels of > nmol/l In the UK we can t rely on diet or sun exposure to achieve these levels EFSA or Vitamin D council recommendations Don t forget bone health as a justification to act now
58 Back-up slide
59 The effect of vitamin D-related interventions on multiple sclerosis relapses: a meta-analysis James et al. Mult Scler Oct;19(12):
60 The conditions for which our human genome was selected offer a reasonable basis for optimal nutrition. Modern humans have existed for 100,000 years Slide adapted from Reinhold Vieth
61 What dose of vd depends where you live? no vd for >6 mo/yr no vd for 1-6 mo/yr vd all year no vd for 1-6 mo/yr no vd for >6 mo/yr Slide adapted from Reinhold Vieth
62 Level of vd supplementation Veith Am J Clin Nutr 1999;69:
63 Cultural changes.
64 Cultural changes
65
66
67
68
69 Do I put my money where my mouth is?
70 Treat-2-Target
71
25-hydroxyvitamin D: from bone and mineral to general health marker
DIABETES 25 OH Vitamin D TOTAL Assay 25-hydroxyvitamin D: from bone and mineral to general health marker FOR OUTSIDE THE US AND CANADA ONLY Vitamin D Receptors Brain Heart Breast Colon Pancreas Prostate
Vitamin D und seine Bedeutung im Immunsystem und bei der Infektabwehr
Vitamin D und seine Bedeutung im Immunsystem und bei der Infektabwehr Stefan Pilz Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Austria Department
Press Information. Vitamin D deficiency
DSM, Corporate Communications P.O. Box 6500, 6401 HJ Heerlen The Netherlands phone +31 (0) 45 578 2421 www.dsm.com Vitamin D is one of the essential nutrients for human health. Unlike other types of vitamins
Selected Questions and Answers on Vitamin D
Selected Questions and Answers on Vitamin D Joint FAQs to the BfR, German Nutrition Society (DGE) und Max Rubner-Institute (MRI) of 03 December 2014 1 Vitamin D promotes the intake of calcium from the
ß-interferon and. ABN Guidelines for 2007 Treatment of Multiple Sclerosis with. Glatiramer Acetate
ABN Guidelines for 2007 Treatment of Multiple Sclerosis with ß-interferon and Glatiramer Acetate Published by the Association of British Neurologists Ormond House, 27 Boswell Street, London WC1N 3JZ Contents
D. Vitamin D. 1. Two main forms; vitamin D2 and D3
D. Vitamin D. Two main forms; vitamin D2 and D3 H H D3 - Cholecalciferol D2 - Ergocalciferol Technically, vitamin D is not a vitamin. It is the name given to a group of fat-soluble prohormones (substances
Key words: Vitamin D Production, Vitamin D Deficiency, and Vitamin D Treatment
Title: Vitamin D Author: Kerry Lynn Kuffenkam Date: 4-29-09 Key words: Vitamin D Production, Vitamin D Deficiency, and Vitamin D Treatment Abstract: Since the term Vitamin D contains the word vitamin most
MULTIPLE SCLEROSIS Update. Disclosures. Multiple Sclerosis. I do not have any disclosures. E. Torage Shivapour, M.D.
MULTIPLE SCLEROSIS Update E. Torage Shivapour, M.D. Clinical Professor Department of Neurology University of Iowa Hospitals & Clinics Disclosures I do not have any disclosures. Multiple Sclerosis Most
Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.
Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many
Question I. A vitamin D deficient mother will give birth. A. True B. False. Answer A
Vitamin D Jatinder Bhatia, MD, FAAP Question I A vitamin D deficient mother will give birth to an infant with Vit D deficiency A. True B. False Answer A Question II Human breast milk has adequate amounts
FOR HEALTH. Huldschinsky 1919. Rickets THE D-LIGHTFUL VITAMIN. Solar UV Radiation. Treated VITAMIN D TOXIC OH FROM SUN EXPOSURE. with Mercury Arc Lamp
THE D-LIGHTFUL VITAMIN W DO YOU MAKE VITAMIN D???? FOR HEALTH Michael F. Holick Boston University Medical Center Solar UV Radiation 7-DHC UV PreD 3 UV UV Tachysterol 3 7-DHC CH2 Vitamin D 3 ΔH PreD 3 Vitamin
Multiple Sclerosis Update. Bridget A. Bagert, MD, MPH Director, Ochsner Multiple Sclerosis Center
Multiple Sclerosis Update Bridget A. Bagert, MD, MPH Director, Ochsner Multiple Sclerosis Center None Disclosures First of All. Why is my talk in the Neurodegenerative hour? I respectfully object! Case
Vitamin D. Sources of vitamin D
1 has been in the news frequently this past year, including an article in The New York Times on November 16, 2009. So what is this vitamin? Why is it important? Most people have heard that vitamin D is
Immunoablative therapy with autologous hematopoietic stem cell transplantation in the treatment of poor risk multiple sclerosis
Immunoablative therapy with autologous hematopoietic stem cell transplantation in the treatment of poor risk multiple sclerosis T Kozák, P Lhotáková Department of Clinical Haematology, 3r d School of Medicine,
Vitamin D. Frequently Asked Questions
Vitamin D Frequently Asked Questions What is vitamin D? What is a vitamin? Why do we need vitamins? Is there more than one form of vitamin D? Where do I get vitamin D? How long should I be outdoors, and
Disclosures. Consultant and Speaker for Biogen Idec, TEVA Neuroscience, EMD Serrono, Mallinckrodt, Novartis, Genzyme, Accorda Therapeutics
Mitzi Joi Williams, MD Neurologist MS Center of Atlanta, Atlanta, GA Disclosures Consultant and Speaker for Biogen Idec, TEVA Neuroscience, EMD Serrono, Mallinckrodt, Novartis, Genzyme, Accorda Therapeutics
Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis
Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic
Advanced Multiple Sclerosis: Progressive MS Epidemiology
Advanced Multiple Sclerosis: Progressive MS Epidemiology CMSC 2007-Washington, DC Mitchell T. Wallin, MD, MPH Associate Director-Clinical Care VA MS Center of Excellence-East East Associate Professor of
Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.
Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many
Cystic fibrosis and bone health
Cystic fibrosis and bone health Factsheet March 2013 Cystic fibrosis and bone health Introduction As we get older our bones become thinner and weaker, and may become more susceptible to fracture. However
Skin Cancer: The Facts. Slide content provided by Loraine Marrett, Senior Epidemiologist, Division of Preventive Oncology, Cancer Care Ontario.
Skin Cancer: The Facts Slide content provided by Loraine Marrett, Senior Epidemiologist, Division of Preventive Oncology, Cancer Care Ontario. Types of skin Cancer Basal cell carcinoma (BCC) most common
News on modifying diseases therapies. Michel CLANET CHU Toulouse France ECTRIMS
News on modifying diseases therapies Michel CLANET CHU Toulouse France ECTRIMS Current treatment strategies Future oral treatments Future non oral treatments Drug safety and risks CIS at risk of MS Active
Orthopaedic Issues in Adults with CP: If I Knew Then, What I Know Now
Orthopaedic Issues in Adults with CP: If I Knew Then, What I Know Now Laura L. Tosi, MD Director, Bone Health Program Children s National Medical Center Washington, DC Epidemiology 87-93% of children born
Supplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Gold R, Giovannoni G, Selmaj K, et al, for
Babies After SCOPE: Evaluating the Longitudinal Impact using Neurological and Nutritional Endpoints
Babies After SCOPE: Evaluating the Longitudinal Impact using Neurological and Nutritional Endpoints Dept of Paediatrics and Child Health, UCC Dept of Obstetrics and Gynaecology, UCC Dept of Food and Nutritional
Refugees with diabetes mellitus have higher prevalence of latent tuberculosis infection
Refugees with diabetes mellitus have higher prevalence of latent tuberculosis infection Matthew Magee Division of Epidemiology and Biostatistics School of Public Health, Georgia State University Saturday,
FastTest. You ve read the book... ... now test yourself
FastTest You ve read the book...... now test yourself To ensure you have learned the key points that will improve your patient care, read the authors questions below. The answers will refer you back to
Vitamin D and You. By Dr. Sherri Tenpenny www.drtenpenny.com www.osteomed2.com
Vitamin D and You By Dr. Sherri Tenpenny www.drtenpenny.com www.osteomed2.com What is Vitamin D? Vitamin D is a fat-soluble vitamin produced in the body when ultraviolet rays from sunlight strike the skin.
Vitamin D & Iron Dosing Guidelines
Vitamin D & Iron Dosing Guidelines Ayman Khmour, MD I have no actual or potential conflict of interest in relation to this program. Objectives Review Ca metabolism Review Recent AAP Guidelines Review CMH
Chapter 15 Multiple myeloma
Chapter 15 Multiple myeloma Peter Adamson Summary In the UK and in the 199s, multiple myeloma accounted for around 1 in 8 diagnosed cases of cancer and 1 in 7 deaths from cancer. There was relatively little
Multiple Sclerosis: a NZ Perspective. Dr Deborah Mason Neurologist Christchurch Hospital
Multiple Sclerosis: a NZ Perspective Dr Deborah Mason Neurologist Christchurch Hospital Multiple Sclerosis in NZ What is MS Epidemiology of MS in NZ Impact of the disease on PwMS Genetic and Environmental
Treatment guidelines for relapsing MS and the two step approach for disease modifying therapy
Treatment guidelines for relapsing MS and the two step approach for disease modifying therapy Klaus Schmierer, PhD FRCP Blizard Institute, Barts and The London School of Medicine & Dentistry Barts Health
Healthy Aging Lab: Current Research Abstracts
Healthy Aging Lab: Current Research Abstracts Arsenic Exposure and Women s Health Environmental exposure to inorganic arsenic is an indisputable source of increased risk of several human cancers and chronic
2.1 Who first described NMO?
History & Discovery 54 2 History & Discovery 2.1 Who first described NMO? 2.2 What is the difference between NMO and Multiple Sclerosis? 2.3 How common is NMO? 2.4 Who is affected by NMO? 2.1 Who first
Vitamin D Status: United States, 2001 2006
Vitamin D Status: United States, 2001 2006 Anne C. Looker, Ph.D.; Clifford L. Johnson, M.P.H.; David A. Lacher, M.D.; Christine M. Pfeiffer, Ph.D.; Rosemary L. Schleicher, Ph.D.; and Christopher T. Sempos,
Appendix: Description of the DIETRON model
Appendix: Description of the DIETRON model Much of the description of the DIETRON model that appears in this appendix is taken from an earlier publication outlining the development of the model (Scarborough
How To Use A Drug In Multiple Sclerosis
Revised (2009) guidelines for prescribing in multiple sclerosis INTRODUCTION In January 2001, the (ABN) first published guidelines for the use of licensed disease modifying treatments (ß-interferon and
The Nuts and Bolts of Multiple Sclerosis. Rebecca Milholland, M.D., Ph.D. Center for Neurosciences
The Nuts and Bolts of Multiple Sclerosis Rebecca Milholland, M.D., Ph.D. Center for Neurosciences Objectives Discuss which patients are at risk for Multiple Sclerosis Discuss the diagnostic criteria for
Nutrition and Parkinson s Disease: Can food have an impact? Sarah Zangerle, RD, CD Registered Dietitian Froedtert Memorial Lutheran Hospital
Nutrition and Parkinson s Disease: Can food have an impact? Sarah Zangerle, RD, CD Registered Dietitian Froedtert Memorial Lutheran Hospital Importance of Nutrition & Parkinson s Disease Good nutrition
Electrohypersensitivity and multiple chemical sensitivity: two clinicbiological. disorder?
5 th Paris Appeal Congress, 18th of May, 2015 Royal Academy of Medicine, Belgium IDIOPATHIC ENVIRONMENTAL INTOLERANCE: WHAT ROLE FOR ELECTROMAGNETIC FIELDS AND CHEMICALS? Electrohypersensitivity and multiple
Big Data for Population Health and Personalised Medicine through EMR Linkages
Big Data for Population Health and Personalised Medicine through EMR Linkages Zheng-Ming CHEN Professor of Epidemiology Nuffield Dept. of Population Health, University of Oxford Big Data for Health Policy
Clinical Trials of Disease Modifying Treatments
MS CENTER CLINICAL RESEARCH The UCSF MS Center is an internationally recognized leader in multiple sclerosis clinical research. We conduct clinical trials involving the use of experimental treatments,
Autoimmunity and immunemediated. FOCiS. Lecture outline
1 Autoimmunity and immunemediated inflammatory diseases Abul K. Abbas, MD UCSF FOCiS 2 Lecture outline Pathogenesis of autoimmunity: why selftolerance fails Genetics of autoimmune diseases Therapeutic
GUIDE FOR VITAMIN D IN CHILDHOOD
GUIDE FOR VITAMIN D IN CHILDHOOD October 2013 Introduction There are many different recommendations for the prevention, detection and treatment of Vitamin D deficiency in the UK. The following is a practical
Multiple Sclerosis (MS) Aprile Royal, Novartis Pharma Canada Inc. September 21, 2011 Toronto, ON
Multiple Sclerosis (MS) Aprile Royal, Novartis Pharma Canada Inc. September 21, 2011 Toronto, ON First-line DMTs Reduce Relapse Frequency by ~30% vs. Placebo Frequency of relapse with various DMTs, based
AUBMC Multiple Sclerosis Center
AUBMC Multiple Sclerosis Center 1 AUBMC Multiple Sclerosis Center The vision of the American University of Beirut Medical Center (AUBMC) is to be the leading academic medical center in Lebanon and the
06/06/2012. The Impact of Multiple Sclerosis in the Pacific Northwest. James Bowen, MD. Swedish Neuroscience Institute
The Impact of Multiple Sclerosis in the Pacific Northwest James Bowen, MD Multiple Sclerosis Center Multiple Sclerosis Center Swedish Neuroscience Institute 1 2 Motor Symptoms of MS Weakness Spasticity
Can I have FAITH in this Review?
Can I have FAITH in this Review? Find Appraise Include Total Heterogeneity Paul Glasziou Centre for Research in Evidence Based Practice Bond University What do you do? For an acutely ill patient, you do
MULTIPLE SCLEROSIS. Megan Snyder INTRODUCTION TO EPIDEMOLOGY
MULTIPLE SCLEROSIS Megan Snyder INTRODUCTION TO EPIDEMOLOGY Snyder 1 Personal Connection to Multiple Sclerosis Multiple sclerosis (MS) is an extremely painful disease of which not enough is understood.
Hold the Sunscreen: Your Body Needs that Vitamin D
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/hold-the-sunscreen-your-body-needs-that-vitamind/4149/
Mutations: 2 general ways to alter DNA. Mutations. What is a mutation? Mutations are rare. Changes in a single DNA base. Change a single DNA base
Mutations Mutations: 2 general ways to alter DNA Change a single DNA base Or entire sections of DNA can move from one place to another What is a mutation? Any change in the nucleotide sequence of DNA Here
Natalizumab (Tysabri) and PMLthe current figures. Paul-Ehrlich-Institut Brigitte Keller Stanislawski Paul-Ehrlich-Str. 51-59 63225 Langen GERMANY
Natalizumab (Tysabri) and PMLthe current figures Paul-Ehrlich-Institut Brigitte Keller Stanislawski Paul-Ehrlich-Str. 51-59 63225 Langen GERMANY Humanised MAB Natalizumab Specific binding to a4-integrin
Accuracy in Space and Time: Diagnosing Multiple Sclerosis. 2012 Genzyme Corporation, a Sanofi company.
Accuracy in Space and Time: Diagnosing Multiple Sclerosis 2012 Genzyme Corporation, a Sanofi company. Brought All rights to reserved. you by www.msatrium.com, MS.US.PO876.1012 your gateway to MS knowledge.
A Definition of Multiple Sclerosis
English 182 READING PRACTICE by Alyx Meltzer, Spring 2009 Vocabulary Preview (see bolded, underlined words) gait: (n) a particular way of walking transient: (adj) temporary; synonym = transitory remission:
HUMAN SKIN COLOR: EVIDENCE FOR SELECTION
OVERVIEW HUMAN SKIN COLOR: EVIDENCE FOR SELECTION This activity supports the viewing of the short film The Biology of Skin Color. Students watch the film in segments and use real data to propose hypotheses,
Steroids. What are steroids?
Steroids What are steroids? Also known as corticosteroids and glucocorticoids, steroids are hormones that are normally produced by the adrenal glands. They are mainly used in multiple sclerosis (MS) because
Nutrition and Toxicants in Autoimmune Disease: Implications for Prevention and Treatment
Nutrition and Toxicants in Autoimmune Disease: Implications for Prevention and Treatment Collaborative on Health and the Environment June 17, 2014 Ted Schettler MD, MPH 1 Autoimmune diseases Autoimmunity
4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH
METABOLIC SYNDROME AN INTEGRATIVE APPROACH AN OPPORTUNITY FOR PHARMACISTS TO MAKE A DIFFERENCE Mike Rizo, Pharm D, MBA, ABAAHP THE EVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THE PHARMACIST OF THE FUTURE?
Medication Policy Manual. Topic: Aubagio, teriflunomide Date of Origin: November 9, 2012
Medication Policy Manual Policy No: dru283 Topic: Aubagio, teriflunomide Date of Origin: November 9, 2012 Committee Approval Date: December 11, 2015 Next Review Date: December 2016 Effective Date: January
Are Men Losing Their Gonads?
Are Men Losing Their Gonads? Andre B. Araujo, Ph.D. Director, Epidemiology New England Research Institutes Watertown, MA 02472 USA [email protected] NIA R01AG020727 Endocrine Society Annual Meeting
HIV New Diagnoses, Treatment and Care in the UK 2015 report
HIV New Diagnoses, Treatment and Care in the UK 2015 report About Public Health England Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities.
ESCMID Online Lecture Library. by author
Do statins improve outcomes of patients with sepsis and pneumonia? Jordi Carratalà Department of Infectious Diseases Statins for sepsis & community-acquired pneumonia Sepsis and CAP are major healthcare
Vitamin D. Why Vitamin D is important and how to get enough
Vitamin D Why Vitamin D is important and how to get enough Why is vitamin D vital for health? Vitamin D is needed by the body for both physical and mental health, but is best known for making sure bones
Corporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testing_serum_vitamin_d_levels 9/2015 2/2016 2/2017 2/2016 Description of Procedure or Service Vitamin D,
Acute Myeloid Leukemia
Acute Myeloid Leukemia Introduction Leukemia is cancer of the white blood cells. The increased number of these cells leads to overcrowding of healthy blood cells. As a result, the healthy cells are not
Osteoporosis has been identified by the US Surgeon General
New Guidelines for the Prevention and Treatment of Osteoporosis E. Michael Lewiecki, MD, and Nelson B. Watts, MD Abstract: The World Health Organization Fracture Risk Assessment Tool (FRAX ) and the National
Protecting and improving the nation s health. Vitamin D. Information for healthcare professionals
Protecting and improving the nation s health Vitamin D Information for healthcare professionals 1 Vitamin D: Information for healthcare professionals Why is vitamin D important? Some of the UK population
Version History. Previous Versions. for secondary progressive MS (SPMS) Policy Title. Drugs for MS.Drug facts box Interferon beta 1b
Version History Policy Title Drugs for MS.Drug facts box Interferon beta 1b for secondary progressive MS (SPMS) Version 1.0 Author West Midlands Commissioning Support Unit Publication Date Jan 2013 Review
Two-Year Phase III Data Presented at AAN 61st Annual Meeting Show Positive Outcome of Cladribine Tablets in Patients with Multiple Sclerosis
Your contact News Release Barbara Fry Phone +1 905 919 0163 April 29/30, 2009 Two-Year Phase III Data Presented at AAN 61st Annual Meeting Show Positive Outcome of Cladribine Tablets in Patients with Multiple
Vitamin D deficiency: the cause of everything?
Health problems linked to vitamin D deficiency: Vitamin D deficiency: the cause of everything? Louise Gagné M.D. Family Physician Saskatoon Community Clinic Clinical Assistant Professor Department of Community
Chapter 20: Analysis of Surveillance Data
Analysis of Surveillance Data: Chapter 20-1 Chapter 20: Analysis of Surveillance Data Sandra W. Roush, MT, MPH I. Background Ongoing analysis of surveillance data is important for detecting outbreaks and
Graves disease in childhood Antithyroid drug therapy
83rd Annual Meeting of the ATA October 620, 203 Duration of antithyroid drugs treatment Disclosure Nothing to disclose Pr Juliane Léger Paediatric Endocrinology Department Paris Diderot University Hôpital
Does referral from an emergency department to an. alcohol treatment center reduce subsequent. emergency room visits in patients with alcohol
Does referral from an emergency department to an alcohol treatment center reduce subsequent emergency room visits in patients with alcohol intoxication? Robert Sapien, MD Department of Emergency Medicine
Vitamin D and its role in immunology: Multiple sclerosis, and inflammatory bowel disease
Progress in Biophysics and Molecular Biology 92 (2006) 60 64 Review Vitamin D and its role in immunology: Multiple sclerosis, and inflammatory bowel disease Margherita T. Cantorna Department of Veterinary
Version History. Previous Versions. Policy Title. Drugs for MS.Drug facts box Glatiramer Acetate Version 1.0 Author
Version History Policy Title Drugs for MS.Drug facts box Glatiramer Acetate Version 1.0 Author West Midlands Commissioning Support Unit Publication Date Jan 2013 Review Date Supersedes/New (Further fields
Unintended consequences: Successful social marketing campaign creates health problems
Unintended consequences: Successful social marketing campaign creates health problems Professor Linda Brennan (corresponding author RMIT, Melbourne Australia ) Professor Gillian Sullivan Mort (presenting
Alzheimer s and Herpes Zoster
The relationship between Alzheimer's and herpes zoster should be studied. A solid link between herpes simplex virus-1 (HSV1) and Alzheimer's has been found. See: "Cold Sore Virus Linked To Alzheimer's
The Influence of Infant Health on Adult Chronic Disease
The Influence of Infant Health on Adult Chronic Disease Womb to Tomb Dr Clare MacVicar Introduction Many diseases in adulthood are related to growth patterns during early life Maternal nutrition important
SQUAMOUS CELL CARCINOMA
SQUAMOUS CELL CARCINOMA What are the aims of this leaflet? This leaflet has been written to help you understand more about squamous cell carcinomas of the skin. It tells you what they are, what causes
acquired chronic immune-mediated inflammatory condition of CNS. MS in children: 10% +secondary progressive MS: rare +primary progressive MS: rare
Immunomodulatory Therapies in Pediatric MS Vuong Chinh Quyen Neurology Department Medscape Mar 8, 2013 Multiple Sclerosis in Children. Iran J Child Neurol. 2013 Spring Introduction acquired chronic immune-mediated
Normal and Abnormal Aging and the Brain. Joel Kramer, PsyD Saul Villeda, PhD Kristine Yaffe, MD
Normal and Abnormal Aging and the Brain Joel Kramer, PsyD Saul Villeda, PhD Kristine Yaffe, MD The myth of cognitive decline The myth of cognitive decline Individual change varies Individual change varies
Stomach (Gastric) Cancer. Prof. M K Mahajan ACDT & RC Bathinda
Stomach (Gastric) Cancer Prof. M K Mahajan ACDT & RC Bathinda Gastric Cancer Role of Radiation Layers of the Stomach Mucosa Submucosa Muscularis Serosa Stomach and Regional Lymph Nodes Stomach and Regional